Provider Demographics
NPI:1376503383
Name:MALEGIANNAKIS, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:MALEGIANNAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1303
Mailing Address - Country:US
Mailing Address - Phone:718-375-7595
Mailing Address - Fax:718-375-7559
Practice Address - Street 1:1811 AVENUE P
Practice Address - Street 2:SUITE # 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1303
Practice Address - Country:US
Practice Address - Phone:718-375-7595
Practice Address - Fax:718-375-7559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY224662OtherLICENSE
NY02499338Medicaid
NY224662OtherLICENSE
NY02499338Medicaid